As a therapist, I am always happy when one of my clients has a “aha” moment. This is that very moment when everything comes together and you just know, it is going to initiate some form of positive change in the client’s disposition. I may have realised it was going to happen some time before it does but key is the client realising it. This makes it far more memorable and is more likely to be sustainable.
I am lucky enough to have been involved in a number of these moments over the years and some just recently which have made all the client’s hard work worthwhile. The weeks of questioning the ability to carry on, weighed down by the past and an imagined future all seem to be forgotten in this moment of realisation. It is one of the most rewarding experiences a client and therapist can go through together. However, it is not a given that this will occur, many things can go wrong before they go right and many variables can be brought to bear on the process.
One of the strongest indicators for success in therapy is the relationship between the therapist and client. This so-called “chemistry” is hugely important and cannot be over-estimated. Some clients will have been in circumstances where there has been virtually nobody they could trust, find reliable or could confide in. The therapist then plays a crucial role in modelling the way relationships really can be. This “chemistry” is also something that cannot be taken for granted. Therapists and clients are human and even the “doctor” title doesn’t shield one from first impressions. That said, it is also the case that if both are clear that the relationship will be difficult after a few sessions, it will probably not get any better, meaning it is perhaps better to look elsewhere. On the other end of the spectrum, many clients see their therapist as a friend, easy to talk to, share secrets with and easy to be around. They often mistake the therapeutic process for friendship and are often disappointed when that “friendship” doesn’t develop after therapy finishes. While it is always nice to have a friendly, open therapist, this is not seen as essential for the process to work. The relationship with a therapist is not the same as friendship. Can a friendship develop after therapy? While not common, it can happen. However, ethical guidelines frown on this for various reasons, including the idea that the transference aspects of the relationship, and the asymmetrical power differential established in therapy, never fully disappear. Above all, despite all the things that can affect the relationship between client and therapist, many studies agree that this relationship is crucial to the process. A recent article in Psychology Today stressed that transference and compatibility are the two biggest factors in the relationship and subsequently how successful therapy can be. While the article specifically looks at clients with depression, the factors can be said to be true for most disorders.
As a therapist I see it as essential to become involved (sometimes daily) with my clients. This does not mean that I go to dinner with them, socialise or become best friends with them but for me, the more traditional approach to therapy where someone sits there, seemingly totally unapproachable and maybe says three words throughout the session as one that does not work for me. I like to think that my relationship with my clients, that is one of honest, open positive regard and reliability is one that they can model and take away with them. I am not saying that the former approach doesn’t work in some circumstances and I have used it before when I felt that boundaries are close to being crossed, I just prefer another approach.
When I have a new client, online or face-to face, many of the initial questions I ask are designed not only to reveal belief systems and the way the client sees the world but also to give insight into the world around them. This means living circumstances, relationships past and present and especially interaction with family and partners. I see these issues as key to paving the way towards recovery working on the feeling that it makes no sense to put a “recovered” client back into a dysfunctional system that will cause relapse. I try to become involved in areas where the client is having particular problems. This means sometimes talking with other family members and partners (with the client’s permission, of course) and maybe inviting these people to become more involved in the overall process. One thing I maintain is that clients can have contact with me via mail or phone between sessions. I set aside time early in the morning to answer mail and I return calls as quickly as I can .